Provider Demographics
NPI:1093467607
Name:MKRTCHYAN, STEPAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPAN
Middle Name:
Last Name:MKRTCHYAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 VINELAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3546
Mailing Address - Country:US
Mailing Address - Phone:818-639-3402
Mailing Address - Fax:818-639-3425
Practice Address - Street 1:4795 VINELAND AVE STE E
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3546
Practice Address - Country:US
Practice Address - Phone:818-639-3402
Practice Address - Fax:818-639-3425
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist